<%@ page language="java" contentType="text/html; charset=utf-8"
	pageEncoding="utf-8"%>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<%@ page import="com.mcms.util.DictUtil" %>
<%@ page import="com.mcms.util.MapUtil" %>
<%@ page import="com.mcms.web.vo.DictCache"%> 
<%@ page import="java.util.*" %>

<%
String path = request.getContextPath();
String basePath = request.getScheme() + "://"
		+ request.getServerName() + ":" + request.getServerPort()
		+ path + "/";
String actionType = request.getParameter("actionType").toString();
String deptCode = request.getParameter("deptCode").toString();
String customId = UUID.randomUUID().toString();
%>	
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<meta http-equiv="X-UA-Compatible" content="IE=7" />
<link href="<%=basePath %>mcms/themes/css/login.css" rel="stylesheet" type="text/css" />
<title>客户信息管理系统</title>
<script type="text/javascript">
<!--

//-->
// 是否预约select的change事件：是-显现预约信息层；否-不显现，并清空内容
function displayData(){
	var flag = $("#appointment option:selected").val();
     alert(flag);
	if(flag == '0' || flag == 0){
	alert("in");
		document.getElementById('dateDiv').style.display='block';
	}else{
	    document.getElementById('appointDate').value = '';
	    document.getElementById('appointmemo').value = '';
		document.getElementById('dateDiv').style.display='none';
	}
	
}
</script>

</head>
<body>
<form id="pagerForm" method="post" action="#rel#">
	<input type="hidden" name="pageNum" value="1" />
	<input type="hidden" name="numPerPage" value="${model.numPerPage}" />
	<input type="hidden" name="orderField" value="${param.orderField}" />
	<input type="hidden" name="orderDirection" value="${param.orderDirection}" /> 
</form>

<div class="pageContent">
	<form method="post" action="<%=request.getContextPath()%>/TransactionServlet?userName=aaa&deptCode=sc&actionType=addCustom_fz&customId=<%=customId%>" class="pageForm required-validate" onsubmit="return validateCallback(this, navTabAjaxDone);">	
		<div class="pageFormContent" layoutH="56">
		<!-- 客户基本资料区域begin -->
			<p>
				<label>
					姓名 ：   
				</label>
				<input id="CUSTOM_NAME" name="CUSTOM_NAME" type="text" size="30"
					value="" class="required" alt="" />
				<span class="unit"></span> 
			</p>
			<p> 
				<label>
					联系手机：
				</label> 
				<input id="TELEPHONE_NO" name="TELEPHONE_NO" class="required digits" 
					type="text" size="30" value="" alt="" />  
				<span class="unit" onclick="document.getElementById('check').value='true';document.getElementById('saveForm').click();document.getElementById('check').value='false';">[已录入?]</span>
				<input type="hidden" name="check" id="check"/>
			</p>
			<p>
				<label>性别：</label>
				<select id="GENDER" name="GENDER" class="combox">
					<option value="">请选择</option>
					<%
							Map map = (Map)DictCache.getInstance().getDictMapByType("SEX");
							Set setInner =map.keySet();//       
							Iterator it=setInner.iterator();//       
							while(it.hasNext()){//     
								String key = (String) it.next();
								%>
								<option value="<%=key%>"><%=(String) map.get(key)%></option>
								<%
							}
							%>
					
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>年龄：</label>
				<input id="AGE" name="AGE" type="text" size="30" value="" alt="" class="digits"/>
			</p>
			<p>
				<label>籍贯：</label>
				<input id="NATIVE" name="NATIVE" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>固定电话：</label>
				<input id="FIXED_TELEPHONE_NO" name="FIXED_TELEPHONE_NO" type="text" size="30" value="" alt="" class="phone"/>
			</p>
			<p>
				<label>住址：</label>
				<input id="ADDRESS" name="ADDRESS" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>EMAIL：</label>
				<input id="EMAIL" name="EMAIL" type="text" size="30" value="" alt="" class="email"/>
			</p>
			<p>
				<label>联系QQ：</label>
				<input id="QQ" name="QQ" type="text" size="30" value="" alt="" class="digits"/>
			</p>
			<p>
				<label>职业：</label>
				<input id="PROFESSION" name="PROFESSION" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>工作地：</label>
				<input id="WORK_PLACE" name="WORK_PLACE" type="text" size="30" value="" alt=""/>
			</p>
			<!-- 客户基本资料区域end -->
			
			<div class="divider"></div>
			
			<!-- 问诊信息区begin -->
			
			<p>
				<label>来院渠道：</label>
				<select id="channel" name="channel" class=" combox">
					<option value="">请选择</option>
					
					<%
					 map = (Map)DictCache.getInstance().getDictMapByType("CHANNEL");
					 setInner =map.keySet();//       
					 it=setInner.iterator();//       
					while(it.hasNext()){//     
						String key = (String) it.next();
						%>
						<option value="<%=key%>"><%=(String) map.get(key)%></option>
						<%
					}
					%>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>咨询项目：</label>
				<select id="refer_item" name="refer_item" class=" combox">
					<option value="">请选择</option>
					
					<%
					 map = (Map)DictCache.getInstance().getDictMapByType("REFER_ITEM");
					 setInner =map.keySet();//       
					 it=setInner.iterator();//       
					while(it.hasNext()){//     
						String key = (String) it.next();
						%>
						<option value="<%=key%>"><%=(String) map.get(key)%></option>
						<%
					}
					%>
					
				</select>
				<span class="unit"></span>
			</p>
			<input type="hidden" id="refer_doctor" name="refer_doctor" value="0"/>
			<!--<p>
				<label>咨询医生：</label>
				<select id="refer_doctor" name="refer_doctor" class=" combox">
					<option value="">请选择</option>
					
					<%
					 map = (Map)DictCache.getInstance().getDictMapByType("REFER_DOCTOR");
					 setInner =map.keySet();//       
					 it=setInner.iterator();//       
					while(it.hasNext()){//     
						String key = (String) it.next();
						%>
						<option value="<%=key%>"><%=(String) map.get(key)%></option>
						<%
					}
					%>
				</select>
				<span class="unit"></span>
			</p>
			--><p>
				<label>脱发情况：</label>
				<select id="bald_condition" name="bald_condition" class=" combox">
					<option value="">请选择</option>
					
					<%
					 map = (Map)DictCache.getInstance().getDictMapByType("BALD_CONDITION");
					 setInner =map.keySet();//       
					 it=setInner.iterator();//       
					while(it.hasNext()){//     
						String key = (String) it.next();
						%>
						<option value="<%=key%>"><%=(String) map.get(key)%></option>
						<%
					}
					%>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>脱发时长：</label>
				<select id="bald_duration" name="bald_duration" class=" combox">
					<option value="">请选择</option>
					
					<%
					 map = (Map)DictCache.getInstance().getDictMapByType("BALD_DURATION");
					 setInner =map.keySet();//       
					 it=setInner.iterator();//       
					while(it.hasNext()){//     
						String key = (String) it.next();
						%>
						<option value="<%=key%>"><%=(String) map.get(key)%></option>
						<%
					}
					%>
					
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>脱发级别：</label>
				<select id="bald_level" name="bald_level" class=" combox">
					<option value="">请选择</option>
					
					<%
					 map = (Map)DictCache.getInstance().getDictMapByType("BALD_LEVEL");
					 setInner =map.keySet();//       
					 it=setInner.iterator();//       
					while(it.hasNext()){//     
						String key = (String) it.next();
						%>
						<option value="<%=key%>"><%=(String) map.get(key)%></option>
						<%
					}
					%>
					
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>是否有家族遗传史：</label>
				<select id="is_inberit" name="is_inberit" class=" combox">
					<option value="">请选择</option>
					<%
					 map = (Map)DictCache.getInstance().getDictMapByType("YN");
					 setInner =map.keySet();//       
					 it=setInner.iterator();//       
					while(it.hasNext()){//     
						String key = (String) it.next();
						%>
						<option value="<%=key%>"><%=(String) map.get(key)%></option>
						<%
					}
					%>
					
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>是否有药物治疗史：</label>
				<select id="is_treat" name="is_treat" class=" combox">
					<option value="">请选择</option>
					<%
					 map = (Map)DictCache.getInstance().getDictMapByType("YN");
					 setInner =map.keySet();//       
					 it=setInner.iterator();//       
					while(it.hasNext()){//     
						String key = (String) it.next();
						%>
						<option value="<%=key%>"><%=(String) map.get(key)%></option>
						<%
					}
					%>
				</select>
				<span class="unit"></span>
			</p>
			 
			
			<!-- 问诊信息区end -->
			 
			
			
		    <div class="divider"></div>
			<div id="dateDiv" style="display:block;"> 
				<p>
					<label>是否预约就诊：</label>
					 
					<select id="is_subscribe_doctor" name="is_subscribe_doctor"  class="combox" onchange="">
						<option value="">请选择</option>
						<%
						 map = (Map)DictCache.getInstance().getDictMapByType("YN");
						 setInner =map.keySet();//       
						 it=setInner.iterator();//       
						while(it.hasNext()){//     
							String key = (String) it.next();
							%>
							<option value="<%=key%>"><%=(String) map.get(key)%></option>
							<%
						}
						%>
					</select>
					<!--  
					<a class="button" href="<%=basePath %>doctor_appointment.html?actionType=yyjz" target="dialog" rel="dlg_page9"><span>预约就诊</span></a>-->
					<span class="unit"></span>
				</p>
				<p>
					<label>预约就诊日期：</label>
					<input type="text" id="subscribe_doctor_time" name="subscribe_doctor_time"  class="date" size="30" /><a class="inputDateButton" href="javascript:;">选择</a>
				</p>
				<dl class="nowrap">
					<dt>备注：</dt>
					<dd><textarea id="remark" name="remark" cols="80" rows="15"></textarea>
					<span class="unit" cols="80" rows="15">&nbsp;(不超过500字)</span>
					</dd>
					
				</dl>
				
				
			</div>
			
			<div class="divider"></div>
			<!--<p>	<a rel="w_uploadify" target="navTab" href="w_uploadify.html" class="button"><span>照片上传</span></a>
			</p>
			<p><label>照片：</label>
			   <img src="<%=basePath %>mcms/themes/default/images/login_banner.jpg"/></p>
			
			-->
			
		</div>
	
		
		<div class="formBar">
			<ul>
				<li><div class="buttonActive"><div class="buttonContent"><button type="submit" id="saveForm">保存</button></div></div></li>
				<!-- <li><div class="buttonActive"><div class="buttonContent"><button type="button" onclick="alertMsg.correct('您的数据提交成功！')">保存</button></div></div></li> -->
				<li>
					<div class="button"><div class="buttonContent"><button type="button" class="close">取消</button></div></div>
				</li>
			</ul>
		</div>
	</form>
</div>


</body>
</html>